Browsing by Author "Dippenaar, Enrico"

Now showing 1 - 4 of 4
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    Open Access
    A descriptive study of demographics, triage allocations and patient outcomes for a private emergency centre in Pretoria for 2018
    (2020) Hedding, Kirsty; Dippenaar, Enrico; Wallis, Lee
    Background Triage aims to detect critically ill patients and to prioritise those with time-sensitive needs. It also contributes to the overall efficiency of an emergency centre (EC). International systems have been relatively well researched; however, no data exists on the use of the SATS score in private healthcare settings in SA. Objectives This study aimed to describe the demographics, triage allocations, time spent in EC and disposition of all patients presenting to a private hospital EC in Pretoria, South Africa in 2018. Methods A retrospective descriptive study was undertaken. Data relating to demographics, triage, and hospital disposition were collected on all patients presenting to the EC during the 2018 calendar year. Descriptive data analyses were conducted in Microsoft Excel. Results A total of 29 055 patients were included in this study. More than half (57.6%) were adults aged 18 to 60 years and approximately one-fourth (27.5%) were paediatrics (<18 years). The majority of patients were triaged yellow (73.5%); 17.4% were triaged as red and orange. It took, on average, 28 minutes to be seen by a provider and patients spent an average of 2 hours and 20 minutes in the EC. Delays to be seen exceeded standards for red and orange patients at 8 and 18 minutes respectively, and the mean time these patients spent in the EC was higher (2h 51 minutes and 2h 47 minutes respectively). Most patients (76.1%) were discharged; 5.6% were admitted to ICU/high care, 14.4% to the general ward, and 3.9% either absconded or refused hospital treatment. Of patients triaged red and orange, 11.1% and 49.3% were discharged respectively, and these patients used the most resources . Conclusion This study found that most of the patients were triaged into low acuity categories (yellow and green) and discharged home. High acuity patients were usually admitted to ICU or high care; however, these patients experienced delays in being treated and admitted. Causes of these issues, and implications on patient outcomes remain unknown. Large numbers of high acuity patients were ultimately discharged home. Further studies are needed to understand the influence of triage accuracy on these patients' outcomes.
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    Identifying the role of pre-hospital intercostal chest drains in South Africa
    (2013) Dippenaar, Enrico; Wallis, Lee
    Includes abstract. Includes bibliographical references.
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    Prehospital emergency care provider’s understanding of their responsibilities towards a mental health care user, during a behavioural emergency
    (2019) Stander, Charnelle; Hodkinson, Peter; Dippenaar, Enrico
    Background: Prehospital emergency care providers in South Africa are regularly called to assist with the management of mental healthcare users. The Mental Health Care Act no 17 of 2002 regulates mental healthcare in South Africa but makes no reference to the roles and responsibilities of prehospital emergency care providers in the provision of mental healthcare, rather giving the South African Police Services authority over the wellbeing of a mental healthcare user outside the hospital setting. Aims: To investigate what prehospital emergency care providers understand their responsibilities are towards a mental healthcare user and the community during the management of a behavioural emergency. Setting: Prehospital emergency care providers from the three main levels of care, currently operational within the boundaries of Pretoria. Methods: A grounded theory qualitative study design was chosen using semi-structured focus groups for each level of prehospital emergency care; Basic Life Support, Intermediate Life Support and Advanced Life Support. Data from each focus group was collected through audio recordings, transcribed and analysed using a framework approach. Results: A total of 19 prehospital emergency care providers from all three main levels of care participated in the focus group discussions (4 BLS, 6 ILS and 9 ALS). Four main themes were identified: Perceptions of behavioural emergencies, responsibilities, understanding of legislation and barriers experienced. Conclusion: Participants placed high value on their moral and medical responsibilities towards a mental healthcare user and would like to have the backing of legislation to fulfil their role. There is a desire for better education, skill development and awareness of mental healthcare in the prehospital emergency care setting.
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    Standardisation and validation of a triage system in a private hospital group in the United Arab Emirates
    (2016) Dippenaar, Enrico; Bruijns, Stevan Raynier; Oliver, Albert
    Introduction: Upon inspection and evaluation of the Mediclinic Middle East emergency centres in the United Arab Emirates, inconsistencies related to triage were found. Of note, it was found that the use of various international triage systems within and between the emergency centres may have caused potentially harmful patient conditions. The aim of this thesis was to study the reliability and validity of existing triage systems within Mediclinic Middle East, and then to use these systems as a starting point to design, standardise and validate a single, locally appropriate triage system. This single triage system should be able to accurately and safely assign triage priority to adults and children within all of Mediclinic Middle East emergency centres. Methods: A System Development Life Cycle process intended for business and healthcare service improvement was expanded upon through an action research design. Quantitative and qualitative components were used in a five-part study that was conducted by pursuing the iterative activities set by an action research approach to establish the following: the emergency centre patient demographic and application of triage, the reliability and validity of the existing triage systems, a determination of the most appropriate triage system for use in this local environment and development of a best-fit novel triage system, establishment of validation criteria for the novel triage system, and determination of reliability and validity of the novel triage system within Mediclinic Middle East emergency centres. Results: Low-acuity illness profiles predominated the patient demographic; high acuity cases were substantially smaller in number. The emergency centres used a combination of existing international triage systems; this was found to be inappropriate for this environment. Poor reliability and validity performance of the existing triage systems led to the development of a novel, four-level triage system. This novel triage system incorporates early warning scores through vital sign parameters, and clinical descriptors. The novel triage system proved to be substantially more reliable and valid than the existing triage systems within the Mediclinic Middle East emergency centres. Conclusion: Through an initial systems analysis, it became clear that the Mediclinic Middle East emergency centres blindly implemented an array of international triage systems. Using an action research approach, a novel triage system that is both reliable and valid within this local environment was developed. The triage system is fit to be implemented throughout all the Mediclinic Middle East emergency centres and may be transposed to similar emergency centre settings elsewhere.